Provider Demographics
NPI:1669030771
Name:MONTERO, MARISOL PEREZ (APRN)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:PEREZ
Last Name:MONTERO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10821 SW 246TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4676
Mailing Address - Country:US
Mailing Address - Phone:786-459-5114
Mailing Address - Fax:
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1087
Practice Address - Country:US
Practice Address - Phone:305-689-3488
Practice Address - Fax:305-689-2563
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP11001354363LF0000X
FLAPRN11001354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily